NERVOUS SYSTEM

Prepared by: Prof. Mike Chavez RN, USRN

1.A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is
confirmed by:
a. A positive Tensilon test c. A positive sweat chloride test
b. Kernig's sign d. Brudzinski's sign

2. While reviewing a client's chart, the nurse notices that the client has myasthenia gravis. Which of the following
statements about neuromuscular blocking agents is true for a client with this condition?
a. The client may be less sensitive to the effects of a neuromuscular blocking agent.
b. Succinylcholine shouldn't be used; pancuronium may be used in a lower dosage.
c. Pancuronium shouldn't be used; succinylcholine may be used in a lower dosage.
d. Pancuronium and succinylcholine both require cautious administration.

3. The physician suspects myasthenia gravis in a client with chronic fatigue, muscle weakness, and ptosis.
Myasthenia gravis is associated with:
a. thyroid disorders b. poor nutrition c. chemotherapy d. a viral infection

4. A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every
3 hours. Before administering this anticholinesterase agent, the nurse reviews the client's history. Which
preexisting condition would contraindicate the use of pyridostigmine?
a. Ulcerative colitis b. Blood dyscrasia c. Intestinal obstruction d. Spinal cord injury

5. The nurse is administering neostigmine to a client with myasthenia gravis. Which nursing intervention should
the nurse implement?
a. Give the medication on an empty stomach
c. Schedule the medication before meals
b. Warn the client that he'll experience mouth dryness
d. Administer the medication for complaints of muscle weakness or difficulty swallowing

6.When obtaining the vital signs of a client with multiple traumatic injuries, the nurse detects bradycardia,
bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings
may reflect which complication?
a. shock b. encephalitis c. increased intracranial pressure d. status epilepticus

7.After striking his head on a tree while falling from a ladder, a young man is admitted to the emergency
department. He's unconscious and his pupils are nonreactive. Which intervention would be the most
dangerous for the client?
a. Give him a barbiturate c. Perform a lumbar puncture
b. Place him on mechanical ventilation d. Elevate the head of his bed

8.A client undergoes a craniotomy with supratentorial surgery to remove a brain tumor. On the first postoperative
day, the nurse notes absence of a bone flap at the operative site. How should the nurse position the client's
head?
a. Flat c. Elevated no more than 10 degrees
b. Turned onto the operative side d. Elevated 30 degrees

9.The nurse is caring for a client with a brain tumor and increased intracranial pressure (ICP). Which intervention
should the nurse include in the plan of care to reduce ICP?
a. Encourage coughing and deep breathing c. Administer stool softeners b. Position with
head turned toward side of brain tumor d. Provide sensory stimulation

10. A young man was running along an ocean pier, tripped on an elevated area of the decking, and struck his
head on the pier railing. According to his friends, "He was unconscious briefly and then became alert and
 behaved as though nothing had happened." Shortly afterward, he began complaining of a headache and asked
to be taken to the emergency department. If the client's intracranial pressure (ICP) is increasing, the nurse
would expect to observe which of the following signs first?
a. Pupillary asymmetry c. Involuntary posturing
b. Irregular breathing pattern d. Declining level of consciousness

11. A client with a head injury is being monitored for increased intracranial pressure (ICP). His blood pressure is
90/60 mm Hg and the ICP is 18 mm Hg; therefore his cerebral perfusion pressure (CPP) is: a. 52 mm Hg b. 88
mm Hg c. 48 mm Hg d. 68 mm Hg

12. The nurse assesses normal pupils in a client who has just been admitted to the intensive care unit after a
craniotomy, and then writes "PERRLA" in the nurse's notes, along with other findings. What does the "E" stand
for in this acronym?
a. Even b. Equal c. Elevated d. Eye

13. A client with hypertension comes to the outpatient department for a routine checkup. Because hypertension is
a risk factor for cerebral hemorrhage, the nurse questions the client closely about warning signs and symptoms of
hemorrhage. Which complaint is a possible indicator of cerebral hemorrhage in this client? a. Frontal headache b.
Nausea c. Vertigo d. Tinnitus

14. A client is admitted to an acute care facility for treatment of a brain tumor. When reviewing the chart, the
nurse notes that the client's extremity muscle strength is rated 1/5. What does this mean? a. Normal, full muscle
strength is present c. Muscle contraction is palpable and visible b. Muscles move actively against gravity
alone d. Muscle contraction or movement is undetectable

15. A client with extensive head injuries is brought to the intensive care unit after a craniotomy. Because
monitoring for increased intracranial pressure (ICP) is a priority for this client, the physician inserts an ICP
monitoring device. What is a normal ICP value?
a. 0 b. Less than 20 mm Hg c. 25 to 35 mm Hg d. 40 to 50 mm Hg

16. The nurse is caring for a client who requires intracranial pressure monitoring. The nurse should be alert for
what major complication of ICP monitoring?
a. Coma b. Infection c. High blood pressure d. Apnea

17. When caring for a client with the nursing diagnosis Impaired swallowing related to neuromuscular impairment,
the nurse should:
a. position the client in a supine position c. encourage the client to remove dentures b. elevate the head
of the bed 90 degrees during meals d. encourage thin liquids for dietary intake

18. Emergency medical technicians transport a 28-year-old iron worker to the emergency department. They tell
the nurse, "He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the
left parietal area. He has a compound fracture of his left femur and he's comatose. We intubated him and he's
maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag." Which
intervention by the nurse has the highest priority?
a. Assessing the left leg c. Placing the client in Trendelenburg's position b. Assessing the
pupils d. Assessing level of consciousness

19. The nurse is caring for a client diagnosed with a cerebral aneurysm who reports a severe headache. Which
action should the nurse perform?
a. Sit with the client for a few minutes c. Inform the nurse manager
b. Administer an analgesic d. Call the physician immediately

20. The nurse is caring for a client with an acute bleeding cerebral aneurysm. The nurse should do all of the
following except:
a. position the client to prevent airway obstruction
b. keep the client in one position to decrease bleeding
c. administer I.V. fluid as ordered and monitor the client for signs of fluid volume excess
d. maintain the client in a quiet environment

21. For a client with suspected increased intracranial pressure, a most appropriate respiratory goal is to:
a. Prevent respiratory alkalosis c. Promote carbon dioxide elimination
b. Lower arterial Ph d. Maintain partial pressure of arterial oxygen (PaO2) above 80 mm Hg

22. For a client with a head injury whose neck has been stabilized, the preferred bed position is:
a. Trendelenburg's b. 30-degree head elevation c. flat d. side-lying

23. A client who has been severely beaten is admitted to the emergency department. The nurse suspects a basilar
skull fracture after assessing:
a. raccoon's eyes and Battle's sign c. motor loss in the legs that exceeds that in the arms b. nuchal
rigidity and Kernig's sign d. pupillary changes

24. A client is admitted in a disoriented and restless state after sustaining a concussion during a car accident.
Which nursing diagnosis takes highest priority in this client's plan of care?
a. Disturbed sensory perception (visual) c. Impaired verbal communication b. Self-care
deficient: Dressing/grooming d. Risk for injury

25. A client is admitted to the surgical intensive care unit with a head injury. A 70-kg athlete, the client must be
maintained on mechanical ventilation. Which drug and initial dosage would the physician most likely prescribe
to help this client breathe with assistance?
a. Gallamine triethiodide (Flaxedil), 70 mg I.V. c. Pancuronium bromide (Pavulon), 7 mg I.M. b. Metocurine
iodide (Metubine), 5.5 mg slow I.V. d. Succinylcholine (Anectine), 90 mg I.V. bolus

26. A client admitted to an acute care facility after a car accident develops signs and symptoms of increased
intracranial pressure . The client is intubated and placed on mechanical ventilation to help reduce ICP. To
prevent a further rise in ICP caused by suctioning, the nurse anticipates administering which drug
endotracheally before suctioning?
a. phenytoin (Dilantin) b. mannitol (Osmitrol) c. lidocaine (Xylocaine) d. furosemide (Lasix)

27. The nurse is caring for a client in a coma who has suffered a closed head injury. What intervention should the
nurse implement to prevent increases in intracranial pressure?
a. Suction the airway every hour and as needed c. Turn the client and change his position every 2 hours b.
Elevate the head of the bed 15 to 30 degrees d. Maintain a well-lit room

28. When caring for a client with a head injury, the nurse must stay alert for signs and symptoms of increased
intracranial pressure (ICP). Which cardiovascular findings are late indicators of increased ICP? a. Hypertension
and bradycardia c. Hypotension and tachycardia
b. Hypotension and bradycardia d. Hypertension and narrowing pulse pressure

29. The nurse is monitoring a client for increasing intracranial pressure (ICP). Early signs of increased ICP include:
a. Pupillary changes c. Decreasing blood pressure
b. Diminished responsiveness d. Elevated temperature

30. A client comes to the emergency department complaining of headache, malaise, chills, fever, and a stiff neck.
Vital sign assessment reveals a temperature elevation, increased heart and respiratory rates, and normal
blood pressure. On physical examination, the nurse notes confusion, a petechial rash, nuchal rigidity, and
Kernig's sign. What do these signs indicate?
a. Increased intracranial pressure (ICP)
b. Cerebral edema
c. Low cerebrospinal fluid (CSF) pressure
d. Meningeal irritation

31. When reviewing the results of a lumbar puncture for a client with suspected bacterial meningitis, the nurse
notes a glucose level of 70 mg/dl. What is the normal glucose level of cerebrospinal fluid (CSF)? a. 0
mg/dl
 b. 10 to 25 mg/dl
c. 50 to 75 mg/dl
d. 80 to 120 mg/dl
32. A client, age 21, is admitted with bacterial meningitis. Which hospital room would be the best choice for this
client?
a. A private room down the hall from the nurses' station
b. An isolation room three doors from the nurses' station
c. A semiprivate room with a 32-year-old client who has viral meningitis
d. A two-bed room with a client who previously had bacterial meningitis

33. The nurse is reviewing the laboratory analysis of cerebrospinal fluid obtained during a lumbar puncture from a
child suspected of having bacterial meningitis. Which of the following results would most likely confirm this
diagnosis?
a. cloudy CSF with low protein and low glucose
b. cloudy CSF with high protein and low glucose
c. clear CSF with low protein and low glucose
d. decreased pressure, cloudy CSF with protein

34. A client undergoes cerebral angiography for evaluation of neurologic deficits. Afterward, the nurse checks
frequently for signs and symptoms of complications associated with this procedure. Which findings indicate
spasm or occlusion of a cerebral vessel by a clot?
a. Nausea, vomiting, and profuse sweating
b. Hemiplegia, seizures, and decreased level of consciousness (LOC)
c. Difficulty breathing or swallowing
d. Tachycardia, tachypnea, and hypotension

35. For a client who has had a cerebrovascular accident (CVA), which nursing intervention can help prevent
contractures in the lower legs?
a. Applying slippers to the client's feet c. Placing hand rolls on the balls of each foot b. Crossing
the client's ankles every 2 hours d. Attaching braces or splints to each foot and leg

36. A client recovering from a cerebrovascular accident (CVA) has right-sided hemiplegia and telegraphic speech
and often seems frustrated and agitated, especially when trying to communicate. However, the chart indicates that
the client's auditory and reading comprehension are intact. The nurse suspects that the client has: a. global aphasia
b. nonfluent aphasia c. fluent aphasia d. anomic aphasia

37. A 70 year old client with a diagnosis is of left-side cerebro-vascular accident (CVA) is admitted to the facility.
To prevent the development of disuse osteoporosis, which of the following objectives is most appropriate? a.
maintaining protein levels
b. maintaining vitamin levels
c. promoting weight- bearing exercises
d. promoting range of motion exercises

38. A client who recently experienced a cerebrovascular accident (CVA) tells the nurse that he has double
vision. Which nursing intervention is the most appropriate?
A. Encourage the client to close his eyes.
B. Alternatively patch one eye every 2 hours.
C. Turn out the lights in the room.
D. Instill artificial tears.

39. After a cerebrovascular accident (CVA), a 75-year-old client is admitted to the facility. The client has left-sided
weakness and an absent gag reflex. He's incontinent and has a tarry stool. His blood pressure is 90/50 mm
Hg, and his hemoglobin is 10 g. Which of the following is a priority for this client?
A. Checking stools for occult blood
B. Performing range-of-motion (ROM) exercises to the left side
C. Keeping skin clean and dry
D. Elevating the head of the bed to 30 degrees

40. The nurse is planning care for a client who suffered a cerebrovascular accident (CVA) in the right hemisphere
of his brain. What should the nurse do?
a. Anticipate the client will exhibit some degree of expressive or receptive aphasia.
b. Place the wheelchair on his left side when transferring the client into a wheelchair.
c. Provide close supervision due to the client's impulsiveness and poor judgment.
d. Support the right arm with a sling or pillow to prevent subluxation.

41. An elderly client has a cerebrovascular accident and can only see the nasal visual field on the side and the
temporal portion on the opposite side. Which of the following terms correctly describes this condition? a.
Ptosis
b. Homonymous HemianopSia
c. Occulogyric crisis
d. Receptive aphasia

42. A 77-year-old client had a thromboembolitic right cerebrovascular accident (CVA); his left arm is swollen.
Which of the following conditions may cause swelling after a CVA?
a. Elbow contracture secondary to spasticity
b. Loss of muscle contraction decreasing venous return
c. Deep-vein thrombosis (DVT) due to immobility of the ipsilateral side
d. Hypoalbuminemia duet to protein escaping from an inflamed glomerulus

43. A white female client is admitted to an acute care facility with a diagnosis of cerebrovascular accident (CVA).
Her history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which history finding is
a risk factor for CVA?
A. Caucasian race
B. Female sex
C. Obesity
D. Bronchial asthma

44. A client injures the spinal cord in a diving accident. The nurse knows that the client will be unable to breathe
spontaneously if the injury site is above which vertebral level?
a. C4 b. T5 c. L2 d. S7

45. A client is thrown from an automobile during a collision. The nurse knows that the client will not be able to
maintain bowel and urinary sphincter control if the injury occurs at what vertebral level? a. C4 b. T5 c. L 2 d. S7

46. Which nursing intervention can prevent a client from experiencing autonomic dysreflexia?
a. Administering chloral hydrate (Noctec)
b. Assessing laboratory test results as ordered
c. Placing the client in Trendelenburg's position
d. Monitoring the patency of an intermittent urinary catheter

47. A client has a history of painful, continuous muscle spasms. He has taken several skeletal muscle relaxants
without experiencing relief. His physician prescribes diazepam (Valium), 2 mg P.O. twice daily. In addition to
being used to relieve painful muscle spasms, diazepam also is recommended for:
a. long-term treatment of epilepsy
b. postoperative pain management of laminectomy clients
c. postoperative pain management of diskectomy clients
d. treatment of spasticity associated with spinal cord lesions

48. A client is admitted with a cervical spine injury sustained during a diving accident. When planning this client's
care, the nurse should assign highest priority to which nursing diagnosis?
a. Impaired physical mobility c. Disturbed sensory perception (tactile)
b. Ineffective breathing pattern d. Self-care deficient: Dressing/grooming
 49. A client with a spinal cord injury and subsequent urine retention receives intermittent catheterization every 4
hours. The average catheterized urine volume has been 550 ml. The nurse should plan to: a. increase the
frequency of the catheterizations c. place the client on fluid restrictions b. insert an indwelling urinary catheter d.
use a condom catheter instead of an invasive one

50. A client with quadriplegia is in spinal shock. What should the nurse expect? a. Absence of
reflexes along with flaccid extremities c. Hyperreflexia along with spastic extremities b. Positive
Babinski's reflex along with spastic extremities d. Spasticity of all four extremities